Rethinking How We Heal from Anxiety and Depression
Five principles to help restore emotional and spiritual well-being
Posted Feb 21, 2019
The stories we tell ourselves matter, and never more than when we’re dealing with a chronic health condition. I found out for myself just how important the story was when I experienced an ongoing struggle with an array of nonspecific symptoms: bouts of profound fatigue, nightly insomnia, digestive problems, depression, a feeling of wearing lead boots, intolerance to stress, and cold sensitivity, among others.
I saw many specialists, got a brain scan, did countless rounds of lab work, and never really got to the bottom of my illness. Needless to say, I was frustrated by the lack of answers and the persistence of the problems. At times I would feel a lot better, only to experience a return of symptoms. As this pattern dragged on, I often found myself saying, "I can't believe I'm still sick."
I didn't realize at the time how that simple statement shaped the way I experienced my symptoms and how I tried to get well. I was sick, and so I needed to find the right doctor, the right diagnosis, the right treatment, the right foods to eliminate, and then I could get better.
And then one day it hit me: I'm still healing. I don't know where the realization came from, but this small shift in how I framed my struggles completely changed my relationship to them. It suggested a very different emphasis—not on finally getting the help that eluded me, but on supporting my body and mind in the process of healing.
This experience stuck with me in my work as a psychotherapist. It led me to take a broader view on the "active ingredients" of treatment—not just the usual suspects of therapy and perhaps medication, but all the conditions necessary for health and wholeness. And it led me to see treatment as just one part of a much bigger process, which doesn't begin or end when a client walks through my door.
For this reason, I was especially struck by the approach of integrative psychiatrist Dr. Omid Naim, who practices in southern California. When I heard that he was an integrative doctor, I thought he probably focused on extensive testing to get to the root cause of conditions like anxiety and depression and emphasized the role of diet in mental health.
I learned something very different—and much more inspiring—in my recent conversation with him on the Think Act Be podcast. Dr. Naim's approach aligned with my own view of what it means to be well, starting with the fundamental elements of a meaningful and satisfying life. His "ecological model" asks what we need to thrive, just as we'd want to know the best growing conditions for a plant we bought. "There's a card that tells you the natural conditions it needs," he said. "How much water, how much sun, what kind of soil." This made him wonder as a psychiatrist, "Why don't we do that with medicine?"
In fact, our lives often look like they were designed specifically to create unease and depression, with our disconnection from others, poor diets, sedentary lifestyle, and lack of meaningful work. In this context, treatment often doesn't stand a chance without the basic nutrients for mental and emotional well-being. It's like giving fertilizer to a plant that's struggling but neglecting to water it and give it adequate sunshine.
Thus we often struggle to heal because we're missing the essential elements of life as we were designed to live it. Unfortunately, these basic needs often don't announce themselves like physical hunger does—or at least we're not able to hear them. For example, we might not recognize when we have a hunger for a sense of purpose. So while we can't imagine starving because we didn't know we needed to eat, we may be starving our minds and spirits by being out of alignment with our true nature.
The following five principles stood out to me from my conversation with Dr. Naim and also have been a part of my own path to recovery.
1. Remember that healing comes from within.
Dr. Naim argues for teaching people from a young age how to take better care of themselves, instilling the idea of a "user's manual" for human beings. An essential part of that manual is understanding that healing and resilience are innate to us. "Resilience isn't something that we apply to ourselves," he told me. "It's more a process of uncovering our resilience." He compared it to the "intelligence that knows how to heal a broken bone."
In contrast, the dominant medical model in the West takes the view that "there's something wrong with you, and I've got the solution. And it's outside of you." Thus depression is often treated as a "chemical imbalance" that requires medication to boost neurotransmitter levels. While many people find drugs like the SSRIs to be very helpful, they are at best a partial fix if there are no accompanying changes in a person's life.
Dr. Naim also expressed concern about how integrative medicine is evolving. "It's often functioning in the same spirit of what's problematic in Western medicine," he said. "So whether it's a chemical imbalance or neurotransmitter testing (which a holistic doctor might do), it's still sending the same message."
He continued, "But if you look at the resilience research, it's not that healthy communities are the ones that do a lot of lab tests or take a lot of supplements. They're not reading self-help books all day and constantly thinking there's something wrong with them and they've got to improve. Medical models that come from wisdom traditions teach about what health looks like," he said. "The starting point isn't disease."
Dr. Naim also noted that "until the 1980s, experiences like anxiety and depression were seen as episodic conditions that went into full remission for the majority of people. But now they're considered chronic diseases, and people are told, 'You have to be on medication for life.'"
He does support the use of psychiatric medication in some situations, "in the way an orthopedic doctor views a cast or a crutch. There's no shame in needing a crutch when you're wearing a cast. Sometimes there's something so fractured that you need outside support. If you walk on a broken leg, the fracture will get worse." As such, he prescribes medication as necessary to support the body's natural healing processes, and only for as long as necessary.
2. Ground yourself in meaningful connection.
Meaningful connection means making room for the spiritual in our lives, which is the foundation of Dr. Naim's approach. That doesn't mean "preaching or prescribing or imposing," he said, but rather something much more basic. It includes acknowledging that we're "governed by meaning," which includes a recognition of the importance of family and community. It also includes a connection to the natural world that we're a part of and that our lives depend on.
Part of the irony of the age we live in is how easy it is to experience disconnection, despite the availability of more ways than ever to connect. As Dr. Naim pointed out, we were designed to exist in closely connected groups that depended on one another for survival. These groups tended to share deeply held "communal values that governed the group as a whole and that were bigger than your subjective needs." We were part of a larger whole, and our welfare and that of the group were inextricably linked. Thus our actions had significance beyond our own narrow self-interest.
"Self-help is only temporarily fulfilling," Dr. Naim said, "if it's just feeling better about myself." But when we link our efforts to change with something meaningful—like the well-being of those we care about—our actions take on a deeper sense of purpose. "We're inspired by things outside of ourselves," he said. "In the short term, we're governed by satisfying our impulses, but if you look at people's long-term behavior, we're driven by a deep, deep need for connection and feeling purposeful."
3. Take time to disconnect from doing.
Healing is most likely to happen when we take time to pause in our busy lives, yet our waking hours tend to be saturated with activity and distraction. Many of us are also addicted to being productive—I know I am. We feel a constant need to do more, even in our "leisure" time. "This is our dilemma from the beginning of history," Dr. Naim said. "If we don't institute ways to disconnect from productivity and entertainment, our need for creativity and stimulation will take over."
We need to make room to stop and reconnect—"with ourselves, with each other, and with nature. That's what the Sabbath is about—to connect with time and space." It's also what mindfulness is about as we allow ourselves to enter a mode of being that's distinct from our compulsive thinking and doing.
There are many ways to create a pause in your life, such as blocking off non-work hours, attending religious services, setting aside time to focus exclusively on the people you're with, reading scriptures or other meaningful texts, or practicing mind-body activities like yoga or tai chi. Notice what happens to your nervous system when you take time to stop.
4. Immerse yourself in space and time.
On a related note, much of our experience is happening in the "timeless and spaceless realm" of our smartphones and other screens. We spend an average of 10 hours a day in front of a screen, "actually dissociated from time and space," Dr. Naim explained. "We're not aware of how radically things are actually changing. It's very subtle, but it's profoundly altering how we experience life."
As more of our activities have become digitized, our experiences have narrowed. No matter what's on the screen we're looking at, it's still a screen, so in a real sense, the scenery never changes when we're consuming technology.
There's a whole world to take in when we stop to look. As with pausing from activity, we need to create gaps in our screen time. Consider leaving your phone at home (gasp!) when you run an errand, or in your bag when you're waiting in line at the store. See what you notice that you would have missed if you'd reflexively taken out your phone to pass the time. See what emerges in your relationships, too, when you're able to focus on the person in front of you.
We also need to spend time outdoors. That doesn't have to mean traveling to a national park—it could be simply a walk around the block, feeling our feet on the earth and noticing the sky above us. There's something undeniably healing about experiencing the natural world.
5. Nourish your body and brain.
More and more evidence is pointing to the important role of nutrition in psychological health. For example, two recent studies found that dietary changes were associated with a significant reduction in depression; other work by Dr. Julia Rucklidge and colleagues has found that micronutrient supplements can be beneficial in decreasing anxiety and promoting resilience to trauma (see Micronutrients in Psychiatry: Sound Science or Just Hype?).
There's no shortage of diet options now, but Dr. Naim recommends simply eating whole foods—the kinds your distant ancestors would recognize. "These are the natural conditions we evolved to live in," he said. And in line with his ecological model, the goal is not to "tell the story that there's something missing in you, or that a specialized diet is going to improve you." He also doesn't subscribe to the idea that there's one best diet for everyone.
What about those who may have food sensitivities? "For some people," Dr. Naim said, "gluten and dairy and other things can make a difference." He recommended a trial-and-error approach. But the majority of people will do very well by eating foods that won't cause inflammation, which means a balanced diet of things like vegetables and fruits, fish, and healthy fats, and one that's low in refined sugar and other highly processed ingredients.
One final point to consider—keep in mind that going through difficulties is an unavoidable part of existence. As Dr. Naim said, "The norm is to go through acute challenges and have to grow." I know I often found myself railing against my problems, telling myself "this shouldn't be happening." The truth is, there were actual reasons for what I was going through, even if I didn't fully understand what they were. The symptoms we experience are the language our bodies and minds use to express themselves. By letting go of the fight against reality, we can redirect our energy in more productive ways—like offering ourselves the right conditions to heal.
The full conversation with Dr. Naim is available here: Telling a Better Story about Health and Healing